Closing system for a natural or an artificial anus

ABSTRACT

The invention relates to a closing system for a natural or an artificial anus, comprising an inflatable balloon having an approximately toroidal structure, composed of a plane tubular section folded in on itself, the ends of which ( 13, 14 ) extend coaxially within each other and are linked to a sleeve.

The invention is directed to a closing system for a natural or anartificial anus.

The medical management of colostomies continues to be an ongoing, dailyproblem. One very common method is to collect the stool in receptaclesthat are used in the form adhesive bags. This extracorporeal storage isassociated with problems of odor nuisance, soiling nuisance and the riskof overflow.

In addition to extracorporeal collection systems, seals were developedwith the objective of intracorporeal storage and subsequent deliberateemptying of the stool. Due to their difficult handling, these collectionsystems did not find very widespread acceptance. The problem was that atrue seal could be achieved. The seals were not equal to the variableinternal abdominal pressure.

People suffering from fecal incontinence have similar problems. Here theaim is to seal the anus with a suitable appliance to preventuncontrolled defecation. Voluntary evacuation, on the other hand, mustbe encouraged or facilitated. Appliances used for this purpose alwaysinclude a hose which is to be inserted in the anus and which, owing toits minimal flexibility, almost always causes pain and can even resultin injury.

These disadvantages of the described prior art give rise to the probleminitiating the invention, that of creating a closing system for anatural or artificial intestinal outlet that is of uncomplicatedconstruction, can readily be implanted, is easy to handle and causes thesmallest possible pressure load on the tissue, particularly theintestinal mucosa. Finally, the system should be inexpensive.

The solution to this problem is achieved by means of an inflatableballoon having an approximately toroidal structure, formed of a hosesegment with a two-dimensional surface, which is inverted into itself,whereby its two ends extend roughly coaxially inside each other and are(each) connected to a sleeve. Advantageous improvements of the inventionare contained in the dependent claims.

The balloon is fabricated preformed and therefore need not be inflatedwith a high overpressure, but only with a few mbars of overpressurerelative to the ambient pressure. It thereby remains flexible in theinflated state and can adapt itself to natural conditions, for examplecan follow an abrupt bend in the intestine, etc. The pressure on theintestinal mucosa is always roughly constant and corresponds only to theinternal pressure of the balloon. It is of great importance that theballoon has no guide shaft, so no such element, even one of reduceddiameter, projects into the intestine. In the absence of a guide shaft,in the invention the inner wall of the torus is formed by the balloonitself; hence its high flexibility.

Both ends of the balloon are situated on one and the same side of thetorus (due to the inversion of the hose), specifically on the sidefacing away from the interior of the person's body. There, the hose isfastened to one or more sleeves, which do not extend all the way throughthe balloon and are shorter than the inflated balloon or shorter thanhalf the length of the original, not-yet-inverted hose, preferably lessthan one-fourth of this original (overall) length of the hose,particularly smaller than one-sixth of this length.

During use, these sleeves are preferably situated outside the body of aperson, or they protrude only slightly through the abdominal wall orextend just to the sphincter muscle. Wearing comfort can be considerablyincreased in this way, since the anus or stoma is not perpetuallystretched. By virtue of the preforming, the mutually concentric ends ofthe balloon or connection ports create a neck region that is taperedwith respect to the balloon per se and extends for example through theanus to the ampulla recti, where the toroidally expanded balloon hasroom to deploy and thereby anchor itself.

The neck region itself remains flexible, thanks to its low internalpressure, and can be compressed cross-sectionally. Since one end of thehose is narrower than the other, a coaxial arrangement of the neckregion leading to the balloon per se is preprogrammed once the inversionhas been effected, and there even remains an annular gap that forms aflow connection from the toroidal interior of the balloon to aconnection at the sleeveward end.

The trumpet shape imparted to the front end of the inflated balloon bythe preforming facilitates, where applicable, the passage of fluids,stool, etc.

On the other hand, the central lumen, which does not communicate withthe interior of the balloon and is therefore completely free ofpressure, can be used for the insertion of tubes or hoses (drainage)and/or catheters or the like. It is advantageous in this regard that thecentral and pressure-free inner lumen is pressed flat by the pressureinside the torus, so that two plies of the hose are contiguous there, ifthe inflated balloon portion of the single-walled outlet hose that isnot invaginated or rolled over is selected so that its length is greaterthan its diameter. The compressed inner hose of the double-hose segmentthen exerts a clamping pressure on an inserted object and thereby holdsit fast in frictional engagement.

In addition, these contiguous plies of the hose form in the respectiveedge region two folds of finite radius, where—assuming that the centrallumen is free, i.e., no object has been inserted—two narrow,capillary-shaped through-passages remain, so that for example anelevated internal pressure in the bowel can be dissipated in the naturalway.

Because an inventive appliance is inserted only partially into thenatural anus, an internal pressure working against the sphincter muscleis able to prompt the latter to react, thereby exercising it. Suchexercise can be intensified by alternately inflating and deflating theballoon.

In other cases, the central lumen can be held open by means of a short,preferably permanently fixed, inserted ring segment; in such cases it isadvisable to employ a sealing element, particularly separatelyinflatable balloons, disposed in the central lumen after this ring.

The balloon, made of a thin-walled, flexible and inflatable polymer, isprefabricated as to its outer dimensions in the inflated state. Theballoon is inflated only in order to deploy the balloon envelope. Thematerial used for the balloon allows the balloon to stretch to only avery small extent, since it is largely inelastic.

The polymer used is preferably polyurethane, a polyurethane/polyvinylfluoride blend, or a comparable polyurethane-based material. Thismaterial is neutral, so it can have absolutely no harmful effects on themucous membrane of the bowel.

In its simplest embodiment, the balloon is provided with a connectinghose port that is joined to the plug. Once the plug has been insertedinto the abdominal wall, the balloon is deployed through a channellocated in the plug and comes into contact by its outer wall with theintestinal wall. To facilitate the insertion of the balloon through theabdominal wall into the intestine, the plug is provided with a cavity inwhich the collapsed balloon can be housed.

The plug itself is preferably form-lockingly connected to a sealing capthat is known per se, which can be glued to the abdominal wall after theplug is inserted into the abdominal wall.

A collection bag to collect the stool can be connected to the channel ofthe plug.

The preferred embodiment of the inventive subject matter, however,provides that the plug comprise two sleeves able to be fitted one insidethe other and that the balloon have two connecting hose ports whosemouths are each connected to a respective one of the sleeves. It isfavorable in this case if the one mouth has a diameter adapted to theouter sleeve and the other mouth a diameter adapted to the inner sleeve.Both mouths can be glued to the sleeve walls. The mouth joined to theouter sleeve is then fastened to the outer wall of the sleeve, whereasthe mouth joined to the inner sleeve is glued to the inner wall of theinner sleeve.

To form the cavity on the plug, the inner sleeve is implemented asshorter than the outer sleeve, so that the cavity present in this regionsuffices to house the collapsed balloon.

In further development, the inner sleeve can be provided in its interiorwith a stop valve. This can be a check valve that keeps fluid in theobturating bladder. In addition, a carbon filter implemented asgas-permeable can be installed in the inner sleeve. The gases producedcan be diverted by this means.

The closing system configured in this manner produces a good seal thatkeeps fluid from escaping to the outside. Moreover, collection bags orthe like are rendered superfluous. To remove the stool, the inner sleevecan be withdrawn from the outer sleeve in a very simple manner and theballoon itself can be pulled through the opening in the outer sleeve. Ifthe balloon is suitably dimensioned, it can serve as the collectingrecipient for the stool.

For cases in which the size of the balloon is not adequate for thispurpose, a special, larger collection receptacle for the stool can beused, which can be connected to the sealing cap by a first adapter andto the inner sleeve by a second adapter. Via the second adapter, theinner sleeve, which is inserted force-lockingly into the outer sleeve,can be withdrawn from the latter. It takes the balloon along with it inthe process, and also withdraws the outer sleeve from the sealing caponce the balloon has been pulled all the way through. The stool can thenbe emptied completely into the collection receptacle.

Further features, characteristics, advantages and effects based on thepresent invention will be apparent from the following description ofseveral preferred exemplary embodiments of the invention and from thedrawing. Therein:

FIG. 1 is a section through an abdominal wall with the closing system inlongitudinal section during the process of implantation in the openingin the abdominal wall;

FIG. 2 shows the implanted closing system in section at the beginning ofthe process of deploying the balloon;

FIG. 3 shows the closing system with the balloon inflated;

FIG. 4 shows the closing system with the inner sleeve and the balloonwithdrawn;

FIG. 5 shows the closing system with a collection receptacle ready to befitted thereto;

FIG. 6 shows the closing system with the inner sleeve withdrawn,including the balloon, and with the collection receptacle intended toreceive the stool;

FIG. 7 is a section through the preformed balloon with hose connectors;

FIG. 8 shows a balloon with an elongated hose connector, implanted in athicker abdominal wall;

FIG. 9 shows an embodiment of the invention corresponding to the balloonfrom FIG. 8, with the insertion of a catheter;

FIG. 10 shows another embodiment of the invention, optimized for use inthe natural intestinal outlet;

FIG. 11 is a section through FIG. 10 along line XI-XI;

FIG. 12 shows a type of construction related to the embodiment depictedin FIGS. 10 and 11 and suitable for receiving a drainage tube;

FIG. 13 depicts a further modified embodiment of the invention; and

FIG. 14 depicts the use of the invention for exercising the sphinctermuscle.

Represented schematically in FIG. 1 is the closing system 1 for use witha colostomy, specifically based on an embodiment in which the plug 2 iscomposed of two sleeves 3 and 4 that can be fitted one inside the other.Inner sleeve 4 is in adjacent contact inserted into outer sleeve 3. Tothis end, it is configured as slightly conical.

In the figure, the closing system 1 is shown being inserted into theopening 5 in the abdominal wall. The abdominal wall 6 is of normalconfiguration. The bowel 7 is sutured by its end 8 to the abdominal wall6 in a manner that is known per se.

With its externally disposed flange 9, outer sleeve 3 grasps the sealingcap 10, which when the plug 2 is inserted completely comes into contactwith the abdominal wall and can be glued thereto. It should be notedthat the sealing cap 10 provides extra security for the patient inregard to the escape of body fluids. In addition, the cap protects theshort segment of bowel exteriorized to the surface of the body. Thissegment is otherwise left unprotected against mechanical irritations. Inparticular, however, the sealing cap helps to prevent the drying andnecrotization which at this location threatens the exteriorized bowelsegment, which is devoid, here, of keratinized epithelium, i.e., naturalliquid barriers. It is also sufficient per se if plug 2 or outer sleeve3 is provided for this purpose with an enlarged annular flange 9 thatcovers the edge of the opening 5 and the exteriorized segment of bowel.As an abutment for the balloon inflated inside the body, the sealingcap—or the flange in the usual case—is not used if the innervation ofthe terminal segment of bowel has been preserved, since the propulsivemovements of the bowel constantly strive to push the obturating balloontoward the outside of the body, against the inner abdominal wall.

Inner sleeve 4 is configured as shortened compared to outer sleeve 3,thereby producing a cavity 11 into which the collapsed balloon 12 can befolded. As shown in FIG. 7, the balloon 12 has two connection ports 13and 14 by which it is connected to outer and inner sleeves 3, 4,respectively.

Balloon 12 with connection ports 13 and 14 is made of a thin-walled,inflatable polymer and has when inflated a diameter D that isappreciably greater than the diameter d of the bowel segment concerned.Diameter D is produced in various sizes and can in this way be adaptedto the size of bowel diameter d. This also applies to the execution ofthe plug 2 and the sleeves 3, 4. In the exemplary embodiment accordingto FIG. 1, the larger connection port 13 is pulled by its mouth 15 ontothe outer wall of sleeve 3. The mouth 16 of connection port 14 isfastened to the inner wall of inner sleeve 4. The fastening can be donewith glue, but clamping rings or the like are also feasible. For theoperation of inflating the balloon 12, which by virtue of its beingfastened to plug 2 is configured as double-walled, channel 17 isprovided in inner sleeve 4.

In FIG. 2, plug 2 is fully inserted in the opening, so that sealing cap10 rests against the abdominal wall. Through the hose nipple 18, air ispressed into the balloon 12 so that the balloon deploys. The beginningof the deployment is particularized in FIG. 2. Therein, the balloon isalready pushed partway out of the cavity 11.

FIG. 3 shows the fully inflated balloon 12, which has assumed the shapeof an annular ring and rests sealingly against the wall of the bowel 7.The preforming of the balloon 12 during manufacture reflects its shapewhen inflated. The annular ring can be of different lengths, so that itis also configured as cylindrical and occupies a longer segment in thebowel 7.

The deployed balloon 12 is configured with respect to its diameter Dsuch that it is larger than the maximally distended bowel, so thatexcess balloon wall material of the outer hose, when inflated, lies infolds, which due to the very small wall thickness form fold “eyelets”roughly the size of capillaries. Fluids are therefore retained in thefold eyelets and the pressure measured externally via the channel 17corresponds to the pressure exerted on the intestinal mucosa, since itis not added to by the wall tension of the material. The pressure on theintestinal wall 7 is therefore sufficient for sealing, although the riskof infarction of the bowel cannot be averted completely in this way. Afactor that is favorable for sealing is that the annular ring also bowsoutward toward the abdominal wall 6 and there presses sealingly againstthe bowel 7 on the inside of the abdominal wall 6.

Installed in the air channel 17 of inner sleeve 4 is a check valve 19that keeps the air in the balloon 12. This valve can be opened ifnecessary and the air vented. Connection port 14 effectively forms aninner wall of the balloon 12, which constitutes an escape channel 20 forthe gases produced in the bowel 7. Installed in this channel 20 or ininner sleeve 4 is a carbon filter 21 that prevents liquid stool fromescaping through said channel 20.

To evacuate the bowel, it is possible in many cases to let the air outof the balloon 12 or open valve 19 or withdraw inner sleeve 4 from outersleeve 3. Withdrawing the inner from the outer sleeve causes theobturating balloon to lose pressure and thus deflate. The entire balloon12 can then be pulled through the inside of outer sleeve 3. The thenexternally disposed balloon 12 can receive the stool. After cap 10 withouter sleeve 3 has been detached from the abdominal wall 6, the stoolcan thus be removed easily and safely.

FIG. 4 shows the position of the balloon 12 in which it has already beenpulled through outer sleeve 3 and is ready to receive the stool.

Since the balloon 12 will not be adequate to receive relatively largeamounts of stool in every case, it is possible to configure the plug 2and/or the sealing cap 10 such that an appropriately configuredcollection bag 23 can be fastened thereto. The collection bag 23 has anannular flange 24 that can be connected to sealing cap 10 and a lid 25that can be placed on inner sleeve 4. By the exertion of traction on lid25, inner sleeve 4 is withdrawn from outer sleeve 3 and, as representedpreviously in FIGS. 3 and 4, balloon 12 is withdrawn through the inneropening of outer sleeve 3. This procedure is illustrated in FIG. 6,wherein outer sleeve 3 is also pulled out of opening 5 or its mountingin the cap 10, so that the stool can be emptied into the collection bag23.

FIG. 7 shows the preformed balloon 12 with the connection ports 13 and14. Connection ports 13 and 14 have a relatively great length. Beforethey are used, i.e. connected to plug 2 or sleeves 3 and 4 of plug 2,connection ports 13 and 14 are custom-cut to an appropriate length,depending on the thickness of the abdominal wall 6.

FIG. 8 shows the implantation of a balloon 12 in association with athicker abdominal wall 6, all other parts being the same as thoseillustrated in FIG. 3. The connection ports 13 and 14 have merely beenleft longer in keeping with the abdominal wall 6, so that thenon-deployable portion of balloon 12 constituted by connection ports 13and 14 still reaches into the bowel 7.

Attention should be paid to the fact that the length of the sleeves 3, 4and of the plug 2 formed therefrom is roughly equal to or only slightlygreater than the thickness of the abdominal wall 6 and therefore—duealso to the depth of sealing cap 10—barely extends into the bowel 7. Thesubsequent course of the bowel 7 is therefore completely arbitrary; itcan even kink immediately beneath the abdominal wall 6.

From the arrangement depicted in FIG. 9, it can be seen that the centrallumen 26 inside the roughly toroidally inflated balloon 12 is alsoparticularly well suited for the insertion of a catheter 27. In thiscase, the slight overpressure inside the balloon volume 28 pressesapproximately radially inward against the central lumen 26 and clampsthe inserted catheter 27 firmly, thereby making it tight. The catheter27 can be permanently fixed in the region of the sleeve segment disposedoutside the body and can be provided with a suitably atraumaticallyshaped tip and a drainage opening for the venting of intestinal gas. Thecatheter fixed in the seal is fashioned with respect to its shaftmechanics such that when the seal is inserted in the body, the cathetercarries the sealing balloon collapsed on the catheter shaft withoutbending and thereby facilitates transanal passage of the seal. Itpreferably measures only a few millimeters (app. 2-4 mm) in diameter.Its tip protrudes only slightly beyond the distal end of the filledballoon body.

FIGS. 10 to 14 below reflect embodiments that are suitable for use witha natural intestinal outlet.

The closing system 1′ used in this case differs only in detail fromthose described hereinabove. For example, the connection ports 13, 14can be configured as somewhat longer, thereby resulting in a pronouncedneck region 29 that extends through the sphincter muscle 30 and makes itpossible for the actual, radially expanded balloon portion 31 to fillthe ampulla 32. Since when the balloon 12 is inflated its radiallyexpanded portion 31 is pressed against the floor of the ampulla 32, thisclosing system 1′ is able to anchor itself in optimum fashion. Theabutment is formed in this case by a longitudinally folded sealing cap33 that is fastened to plug 2 and whose shape is adapted to the anatomyof the anal fold 34. The sealing cap 33 can be provided with a softfleece on the outer sides of its two wings.

As a side effect of inflation, the balloon volume 28 also pressesagainst the central lumen 26 and in so doing collapses inner hosesegment 14, as indicated in FIG. 11 by the thick line. The central lumen26 is thereby largely sealed. Nevertheless, due to the limiteddeformability of the thicker hose material on the inner hose segment 14,capillary-shaped passages 36 do remain on both sides of the double-plyregion 35 and permit the escape of gases, but not liquids.

FIG. 12 shows that this embodiment 1′ is also suitable for the insertionof a drainage tube 37 by means of which flushing of the bowel 7 can beeffected. For this purpose, a liquid, for example water, is conveyedinto the bowel 7 by means of a hose 38 guided through this tube 37. Tocarry off the outflowing liquid, a hose 39 is connected to, particularlyslipped over, the external end of the drainage tube 37.

With the closing system 1′ of FIG. 13, the natural intestinal outlet canbe sealed, but normal evacuation of the bowel can also be brought aboutas necessary. For this purpose, the central lumen 26 is held constantlyopen by a ring or a short tube segment 40, which is fixed to inner hosesegment 14 only in punctiform or linear fashion. This ring or short tubesegment 40 is shorter than the axial extent of the radially expandedballoon portion 31. It is connected to the also ring-shaped plug 2 onlyvia the neck portion of balloon 12 formed by connection ports 13, 14.Attached at the far end of this ring or plug 2 is a hose segment 41. Therings 2, 40 and hose segment 41, which is more rigid than balloon 12,hold central lumen 26 continuously open, so that spontaneous defecationis possible. In order, conversely, to control and even suppress orpostpone such defecation, there is provided in central lumen 26, in necksegment 14, [in] one of the rings 2, 40 and/or in the hose segment 41 aninfluencable sealing element in the form of a second, separatelyinflatable balloon 42, which for example can be affixed by means of glueor the like to the inner face of the segment 2, 14, 26, 40, 41 concernedand can be filled or emptied via a separate line. To be able to alsostimulate defecation, an additional line 43 is provided, which forexample passes through the plug or ring 2 into the central lumen 26 andcan be anchored by its end for example to the front ring 40. Throughthis line 43, for example water or another liquid can be introduced inorder to flush out the bowel.

If in this embodiment 1′ the length L of the balloon region 31 that ispreformed to the shape of the abdomen is shorter than its outer diameterD, then—given a moderate overpressure inside the balloon 12—ring 40 isnot necessary to keep the central lumen 26 open, because in this case atoroidal shape is created that is nearly ideal and is therefore alwaysopen at the center 26.

Another application for the inventive closing system 1′ is illustratedin FIG. 14. Here, the balloon 12 is not inserted completely into thebowel 7, but only partially, so that it is located just at the level ofthe sphincter muscle 30. Then, by variably raising and lowering thepressure inside the balloon volume 28, the sphincter muscle 30 can bestretched and an opposite closing reflex can be elicited. By repeatingthis process, the sphincter muscle 30 can be exercised regularly toactively reduce fecal incontinence. To better guard against dislocationof the balloon 12 during normal physical movement of the patient(walking, sitting), the balloon can in the transanal segment be suitablypreformed with a taper, or waisted (about 2-5 cm in diametertransanally).

To make the sealing apparatus usable for the self-care orself-initiation of hemorrhoidal bleeding by the patient, the body can besupplemented by an initiating and drainage element similar to that shownin FIG. 9, preferably permanently fixed in the sleeve terminatingsegment.

1. A closing system for a natural or artificial anus, comprising aninflatable balloon having a generally toroidal structure, formed of ahose segment with a two-dimensional surface, which hose is inverted intoitself, whereby its two ends (13, 14) extend generally coaxially witheach other and are connected to a respective sleeve.
 2. The closingsystem in accordance with claim 1, wherein said balloon (12) ispreformed with two connection ports (13, 14) or ends.
 3. The closingsystem as recited in claim 2, characterized in that said connectionports (13, 14) or ends of said balloon (12) are preformed such that eachor both of end regions (13, 14) of the inverted hose segment have agenerally constant cross-sectional length.
 4. The closing system inaccordance with claim 3, wherein said connection ports (13, 14) or endsof said balloon (12) are preformed such that cross sections through thetwo ends of the inverted hose have different lengths that correspond todifferent circumferential lengths of said end regions.
 5. The closingsystem in accordance with claim 1, wherein the inverted hose ispreformed such that its front end, which is distal relative to themutually coaxial ends, assumes in an inflated state a gently curvedcontour with no edge regions.
 6. The closing system in accordance withclaim 2, wherein said balloon is preformed such that it has in aninflated state a diameter that exceeds a diameter of a bowel segment. 7.The closing system in accordance with claim 6, wherein the length of thesleeve(s) is in each case smaller than one third the length of theballoon measured coaxially to the axis of symmetry of the inflatedballoon.
 8. The closing system in accordance with claim 6, wherein thecollapsed balloon (12) is housed in a cavity (11), which is provided ina plug (2) and is directed toward an interior of the bowel.
 9. Theclosing system as recited in claim 8, characterized in that twoconnection ports (13, 14) of said balloon (12) are each connected bytheir mouths to said plug (2).
 10. The closing system as recited inclaim 8 wherein said plug (2) comprises two sleeves (3, 4) that can befitted one inside the other and in that a mouth (15, 16) of eachconnection port (13, 14) is connected to a respective one of saidsleeves (3, 4).
 11. The closing system as recited in claim 10, whereinthe mouth (15) that is connected to an outer (3) of the sleeves has adiameter adapted to the outer sleeve (3), and the mouth (16) that isconnected to the inner (4) of the two sleeves has a diameter adapted tothe inner sleeve (4).
 12. The closing system as recited in claim 11,wherein said balloon (12) can be pulled through the outer sleeve (3).13. The closing system as recited in claim 11 wherein the inner sleeve(4) comprises an air channel (17).
 14. The closing system as recited inclaim 13, characterized in that said air channel (17) comprises a stopvalve (19).
 15. The closing system as recited in claim 11, wherein acarbon filter (21) can be disposed inside the inner sleeve (4).
 16. Theclosing system in accordance with claim 10, wherein said plug (2) and/orone or more sleeves is/are connectable to a sealing cap (10).
 17. Theclosing system as recited in claim 16, characterized in that saidsealing cap (10) is connected in adjacent contact to said plug (2). 18.The closing system as recited in claim 16, wherein said sealing cap hasa folded structure.
 19. The closing system in accordance with claim 16,wherein said sealing cap (10) and/or said plug (2) is connectable to acollection bag (23).
 20. The closing system in accordance with claim 19,wherein the collection bag (23) is connectable to said sealing cap (10)and to the inner sleeve (4).
 21. The closing system in accordance withclaim 1, wherein said balloon is made of a thin-walled polymer.
 22. Theclosing system in accordance with claim 21, wherein said polymer is aselected one of polyurethane, a polyurethane/polyvinyl chloride blendand a comparable polyurethane-based material.
 23. The closing system inaccordance with claim 1, wherein a ring-shaped element is fixed in acentral lumen of the hose segment inverted into itself, the fixing beingeffected only along a narrow, circumferentially surrounding line so asnot to deteriorate freedom of movement of the balloon.
 24. The closingsystem in accordance with claim 23, wherein an externally controllablesealing element in the form of a separately inflatable balloon isdisposed in the central lumen of the hose segment inverted into itself.25. The closing system in accordance with claim 24, wherein a tube canbe inserted through the central lumen of the hose segment inverted intoitself.